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The toxicity and efficacy of donor lymphocyte infusions given after reduced-intensity conditioning allogeneic stem cell transplantation

The toxicity and efficacy of donor lymphocyte infusions given after reduced-intensity conditioning allogeneic stem cell transplantation
The toxicity and efficacy of donor lymphocyte infusions given after reduced-intensity conditioning allogeneic stem cell transplantation
We describe the toxicity and efficacy of donor lymphocyte infusions (DLIs) given to 81 patients (median age, 50 years) after reduced-intensity conditioning (RIC) transplantations performed at 16 centers in the United Kingdom. The diseases treated included non-Hodgkin lymphoma (NHL; n = 29), chronic myeloid leukemia (CML; n = 12), myeloma (n = 11), acute myeloid leukemia (AML; n = 10), and chronic lymphocytic leukemia (CLL; n = 9). Eighty-eight percent received stem cells from sibling donors. The patients received 130 infusions (median, 1; range, 1-4). Indications for DLI were unsatisfactory response/disease progression in 51 patients, mixed chimerism in 18, preemptive in 10, and other in 2. Graft hypoplasia was uncommon (11%). Grade II to IV graft-versus-host disease (GVHD) occurred in 23 of 81 patients (28%) and limited and extensive chronic GVHD in 5 of 69 and 18 of 69 evaluable patients (total incidence 33%). Conversion from mixed to full donor chimerism occurred in 19 of 55 evaluable patients (35%) at a median of 48 days after the DLI; partial responses occurred in 6 patients (total response rate 45%). Eighteen of 51 (35%) patients with measurable disease after stem cell transplantation had a complete response (2 molecular), and 5 a partial response (total response rate 45%). Eleven of 17 evaluable complete responders had full donor chimerism. Eight of 13 patients with follicular NHL had complete responses as did 4 of 12 patients with CML. Clinical and chimeric responses correlated strongly with acute and chronic GVHD. Forty-seven patients (58%) survive at a median of 508 days after transplantation (range, 155-1171 days) with a median Karnofsky score of 90. Thirty-four patients (42%) died at a median of 211 days after transplantation with the major causes being progressive disease (26%) and GVHD (9%). Further systematic studies are required to determine the efficacy and optimum use of DLI for patients with each disease treated by nonmyeloablative stem cell transplantation.
0006-4971
3108-3114
Marks, David I.
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Lush, Richard
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Cavenagh, Jamie
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Milligan, Donald W.
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Schey, Steven
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Parker, Anne
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Clark, Fiona J.
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Hunt, Linda
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Yin, John
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Fuller, Steven
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Vandenberghe, Elisabeth
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Marsh, Judith
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Littlewood, Timothy
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Smith, Graeme M.
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Culligan, Dominic
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Hunter, Ann
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Chopra, Rajesh
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Davies, Andrew
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Towlson, Keiren
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Williams, Catherine D.
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Marks, David I.
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Lush, Richard
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Cavenagh, Jamie
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Milligan, Donald W.
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Schey, Steven
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Parker, Anne
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Clark, Fiona J.
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Hunt, Linda
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Yin, John
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Fuller, Steven
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Vandenberghe, Elisabeth
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Marsh, Judith
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Littlewood, Timothy
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Smith, Graeme M.
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Culligan, Dominic
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Hunter, Ann
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Chopra, Rajesh
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Davies, Andrew
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Towlson, Keiren
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Williams, Catherine D.
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Marks, David I., Lush, Richard, Cavenagh, Jamie, Milligan, Donald W., Schey, Steven, Parker, Anne, Clark, Fiona J., Hunt, Linda, Yin, John, Fuller, Steven, Vandenberghe, Elisabeth, Marsh, Judith, Littlewood, Timothy, Smith, Graeme M., Culligan, Dominic, Hunter, Ann, Chopra, Rajesh, Davies, Andrew, Towlson, Keiren and Williams, Catherine D. (2002) The toxicity and efficacy of donor lymphocyte infusions given after reduced-intensity conditioning allogeneic stem cell transplantation. Blood, 100 (9), 3108-3114. (doi:10.1182/blood-2002-02-0506).

Record type: Article

Abstract

We describe the toxicity and efficacy of donor lymphocyte infusions (DLIs) given to 81 patients (median age, 50 years) after reduced-intensity conditioning (RIC) transplantations performed at 16 centers in the United Kingdom. The diseases treated included non-Hodgkin lymphoma (NHL; n = 29), chronic myeloid leukemia (CML; n = 12), myeloma (n = 11), acute myeloid leukemia (AML; n = 10), and chronic lymphocytic leukemia (CLL; n = 9). Eighty-eight percent received stem cells from sibling donors. The patients received 130 infusions (median, 1; range, 1-4). Indications for DLI were unsatisfactory response/disease progression in 51 patients, mixed chimerism in 18, preemptive in 10, and other in 2. Graft hypoplasia was uncommon (11%). Grade II to IV graft-versus-host disease (GVHD) occurred in 23 of 81 patients (28%) and limited and extensive chronic GVHD in 5 of 69 and 18 of 69 evaluable patients (total incidence 33%). Conversion from mixed to full donor chimerism occurred in 19 of 55 evaluable patients (35%) at a median of 48 days after the DLI; partial responses occurred in 6 patients (total response rate 45%). Eighteen of 51 (35%) patients with measurable disease after stem cell transplantation had a complete response (2 molecular), and 5 a partial response (total response rate 45%). Eleven of 17 evaluable complete responders had full donor chimerism. Eight of 13 patients with follicular NHL had complete responses as did 4 of 12 patients with CML. Clinical and chimeric responses correlated strongly with acute and chronic GVHD. Forty-seven patients (58%) survive at a median of 508 days after transplantation (range, 155-1171 days) with a median Karnofsky score of 90. Thirty-four patients (42%) died at a median of 211 days after transplantation with the major causes being progressive disease (26%) and GVHD (9%). Further systematic studies are required to determine the efficacy and optimum use of DLI for patients with each disease treated by nonmyeloablative stem cell transplantation.

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Published date: 1 November 2002

Identifiers

Local EPrints ID: 73360
URI: http://eprints.soton.ac.uk/id/eprint/73360
ISSN: 0006-4971
PURE UUID: fd438501-6a6b-4b67-99e5-f5914ac96d6f
ORCID for Andrew Davies: ORCID iD orcid.org/0000-0002-7517-6938

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Date deposited: 09 Mar 2010
Last modified: 03 Feb 2020 01:30

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Contributors

Author: David I. Marks
Author: Richard Lush
Author: Jamie Cavenagh
Author: Donald W. Milligan
Author: Steven Schey
Author: Anne Parker
Author: Fiona J. Clark
Author: Linda Hunt
Author: John Yin
Author: Steven Fuller
Author: Elisabeth Vandenberghe
Author: Judith Marsh
Author: Timothy Littlewood
Author: Graeme M. Smith
Author: Dominic Culligan
Author: Ann Hunter
Author: Rajesh Chopra
Author: Andrew Davies ORCID iD
Author: Keiren Towlson
Author: Catherine D. Williams

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